Nursing Management:

Musculoskeletal Trauma and

Orthopedic
Surgery

By: Aun Lauriz E. Macuja

SAC_SN4

 The most common cause of

musculoskeletal injuries is a traumatic
event resulting in fracture, dislocation,
and associated soft tissue injuries.
Nurses have an important role in public
education about the basic principles of
safety and accident prevention.

SOFT-TISSUE
INJURIES
A sprain is an injury to
tendinoligamentous
structures surrounding
a joint, usually caused
by wrenching or twisting
motion.

A strain is an
excessive stretching of
a muscle and its fascial
sheath. It often involves
the

 Symptoms of sprains and strains are similar it include

pain, edema, decrease in function, and contusion.
Mild sprains and strains are usually self-limiting, with full
function returning within 3 to 6 weeks.
Severe strains may require surgical suturing of muscle
and surrounding fascia.
Stretching and warm-up prior to exercising and before
vigorous activity significantly reduces sprains and
strains.

DISLOCATION
Dislocation is a severe injury of the
ligamentous structures that
surround a joint.
The most obvious sign is DEFORMITY,
also local pain, tenderness, loss of
function of injured part, and swelling of
soft tissues in joint region.
Requires prompt attention with the
dislocated joint first realigned in its
original anatomic position.
Extremity then is immobilized by
bracing, taping, or using a sling to allow
torn ligaments and tissue time to heal.

SUBLUXATION
Subluxation is a partial or
incomplete displacement of the
joint surface.
Manifestations are similar to a
dislocation but are less severe.
Treatment is similar to a
dislocation, but it may require less
healing time.
The nursing care is directed toward
pain relief , support and protection
of injured joint.

REPETITIVE STRAIN INJURY

Repetitive strain injury (RSI) is a cumulative
traumatic disorder resulting from prolonged,
forceful, or awkward movements.
It can be prevented through education and ergonomics.
Treatment includes identifying the precipitating
activity, modification of activity, pain management
with heat/cold application, drugs, rest, physical therapy
for strengthening and conditioning, and lifestyle
changes.

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) is caused by
compression of the median nerve, which enters
the hand through the narrow confines of the carpal
tunnel.
It is often caused by pressure from trauma or edema
caused by inflammation of tendon, rheumatoid
arthritis, or soft tissue masses.
Signs are weakness (especially in thumb), burning
pain, and numbness.
Holding the wrists for 60 seconds produces tingling
and numbness over the distribution of the median
nerve, a positive Phalens test.
Prevention involves educating employees and
employers to identify risk factors.

Early symptoms usually

relieved by stopping the
aggravating movement
and by placing hand and
wrist at rest by
immobilizing them in a
hand splint

Injection of a
corticosteroid drug
directly into carpal
tunnel may provide
some relief.

ROTATOR CUFF
INJURY Rotator cuff injury may occur

gradually from aging, repetitive

stress, or injury to the shoulder
while falling.
Manifestations include shoulder
weakness and pain and
decreased range of motion.
Conservative treatment
involves rest, ice and heat,
NSAIDs, corticosteroid
injections into joint, and
physical therapy.
Surgery may be done with
complete tear or no
improvement with conservative
therapy.

MENISCUS
INJURIES
Meniscus injuries are associated with ligament sprains
that commonly occur in athletes.
Pain is elicited by flexion, internal rotation, and then knee
extension. Surgery may be indicated for a torn meniscus.
Proper stretching may make the patient less prone to
meniscal injury when a fall or twisting occurs.

BURSITIS
Bursitis results from repeated or excessive
trauma or friction, rheumatoid arthritis, or
infection.
Manifestations are warmth, pain, swelling, and
limited ROM in the affected part.
Rest is often the only treatment needed for bursitis.

FRACTUR
Fracture is a disruption or break in the continuity
E
of the bone structure.
Traumatic injuries account for the majority of fractures.
It often described according to:1) type 2)
communication or non-communication with the
external environment, and 3) anatomic location.
Signs include immediate localized pain, decreased
function, and inability to bear weight or use affected
part. Obvious bone deformity may/may not be present.
It require nursing assessments of the peripheral
vasculature (color, temperature, capillary refill,
peripheral pulses, and edema) and neurologic systems
(sensation, motor function, and pain).
Treatment goals are anatomic realignment of bone
fragments, immobilization to maintain realignment, and
restoration of function.

 Lower extremity injuries are often immobilized by casts,

dressings, or splints/immobilizers.
The majority of fractures heal without complications, which
include bone infection, a vascular necrosis, compartment
syndrome, venous thrombosis, fat embolism, and
shock.
Nursing care involves comfort measures for pain,
maintenance of nutrition, and prevention of complications
associated with immobility.
A Colles fracture is a fracture of the distal radius. Usually
managed by closed manipulation, by immobilization by splint
or a cast, or, if displaced, by internal or external fixation.
Fractures involving the shaft of the humerus are a common
injury among young and middle-aged adults. If surgery is
done, skin or skeletal traction may be used for reduction
and immobilization.
Pelvic fractures range from benign to life threatening
depending on mechanism of injury and associated vascular
insult.

 Physical examination demonstrates local swelling,

tenderness, deformity, unusual pelvic movement, and
echymosis on abdomen.
Treatment depends on the injury severity and ranges
from limited intervention to pelvic sling traction, hip
spica casts, external fixation, and open reduction.

HIP
FRACTURE
Hip fractures are common in older adults.
Manifestations are external rotation, muscle spasm, shortening
of affected extremity, and severe pain in region of fracture.
Surgical repair is preferred for managing intra-capsular and
extra-capsular fractures.
After surgeryin addition to teaching on how to prevent
prosthesis dislocationthe nurse should place a large pillow
between patients legs when turning, avoid extreme hip
flexion, and avoid turning the patient on affected side until
approved by surgeon.
The nurse assists both the patient and family in adjusting to
restrictions and dependence imposed by hip fracture.

AMPUTATIO
N

Older persons have the highest incidence of

amputation due to effects of peripheral
vascular disease, atherosclerosis, and
diabetes.
Indications for amputation include circulatory
impairment resulting from a peripheral
vascular disorder, traumatic and thermal
injuries, malignant tumors, and infection of the
extremity.
Goal of surgery is to preserve extremity length
and function while removing all infected,
pathologic, or ischemic tissue.
Goals for the nurse are that the patient will
have pain relief from the underlying health
problem, satisfactory pain control, maximum
rehabilitation potential, and ability to cope with
the body image changes.

JOINT REPLACEMENT
SURGERY
Joint
replacement surgery is the most common
orthopedic operation performed on older
adults.

Surgery is aimed at relieving pain, improving

joint motion, correcting deformity and malalignment, and removing intra-articular causes
of erosion.
Types of joint surgeries include synovectomy,
osteotomy, debridement, and
arthroplasty.
Arthrodesis is the surgical joint fusion
which may be done if articular surfaces
are too damaged or infected to allow joint
replacement or for reconstructive surgery
failures.
Postoperatively, neurovascular assessment is
performed to assess nerve function and
circulatory status. Anticoagulation therapy,
analgesia, and antibiotics are administered.

 Ambulation is encouraged as early as possible to prevent

immobility complications.
Patient discharge teaching includes instructions on
reporting complications, including infection and
dislocation of the prosthesis (e.g., pain, loss of function,
shortening or malalignment of an extremity).

Thats all FOLKS..

Thank You for Listening!

Hula-Hula Go
1. The Goal of this surgery is to preserve extremity
length and function while removing all infected,
pathologic, or ischemic tissue.
2. Is a partial or incomplete displacement of the
joint surface. Manifestations are similar to a
dislocation but are less severe. Treatment is similar to
a dislocation, but it may require less healing time.
3. An excessive stretching of a muscle and its
fascial sheath. It often involves the tendon.
4. The surgical joint fusion which may be done if
articular surfaces are too damaged or infected to
allow joint replacement or for reconstructive surgery
failures.
5. Provocative test used in the diagnosis of carpal
tunnel syndrome.

MATCHING TYPE
6. Sprain
7. Repetitive Strain
Injury
8. Meniscus
9. Bursitis
10. Greenstick

 Pick one
Musculoskeletal
Trauma and
Orthopedic
Surgery and
Explain it also
state its
symptoms.
(5points)